Revisão Narrativa
COVID-19 Vaccine in Children: Current Evidence and Recommendations
Conteúdo principal do artigo
Teresa Nunes David
João Bismarck Pereira
Resumo
A vacinação contra a COVID-19 constituiu uma estratégia fundamental no controlo da pandemia e o seu benefício foi maior nos grupos de maior risco e com maior mortalidade.
As crianças e adolescentes com COVID-19 apresentam, em geral, doença ligeira e frequentemente assintomática, mas existem manifestações clínicas graves respiratórias e/ou inflamatórias associadas em que há necessidade de internamento hospitalar e, em cerca de um terço dos casos, em unidades de cuidados intensivos (UCI).
A mortalidade por COVID-19 das crianças e adultos jovens é baixa e a existência de doenças crónicas ou condições médicas subjacentes tem relevância para a gravidade clínica e para o prognostico.
Atualmente, após declaração do final da pandemia em Maio de 2023, a vacinação das crianças em Portugal deixou de abranger crianças saudáveis, mas inclui as crianças com imunossupressão e doenças crónicas. Seguindo as recomendações da OMS, vários países europeus adotaram uma estratégia semelhante. Outros países como os Estados Unidos da América mantêm vacinação de crianças saudáveis como parte da estratégia de saúde pública para controlo da doença e melhoria da imunidade.
Em Portugal, a vacinação das crianças pertencentes aos grupos de risco implica o envolvimento dos pediatras, que nas várias áreas seguem crianças com doenças crónicas e que poderão ter um papel relevante contrariando a hesitação vacinal, resultado de desconhecimento, má informação e de uma perceção errada de baixo risco.
Detalhes do artigo
Este trabalho encontra-se publicado com a Creative Commons Atribuição-NãoComercial 4.0.
Referências
World Health Organization. Coronavirus disease (COVID-19): Vaccines and vaccine safety. [accessed October 12, 2024] Available at: https://www.who.int/europe/emergencies/situations/covid-19/covid-19-vaccination.
UNICEF. COVID-19 confirmed cases and deaths. [accessed October 12, 2024] Available at: https://data.unicef.org/topic/child-survival/covid-19/.
Centers for Disease Control and Prevention. Child and Adolescent Immunization Schedule. [accessed October 12, 2024] Available at: https://www.cdc.gov/vaccines/hcp/imz-schedules/child-adolescent-notes.html#note-covid-19
Direção Geral de Saúde. Estratégia de Vacinação contra a Covid -19. Norma nº 08/2024.Atualizada a 6/9/2024. Lisboa: DGS; 2024.
Ludvigsson JF. Systematic review of COVID-29 in children shows milder cases and a better prognosis than in adults. Acta Paediatr. 2020;109:1088-95. doi: 10.1111/apa.15270.
Fayad D, Frenck RW Jr. COVID-19 Vaccines in Children. J Clin Med. 2023;13:87. doi: 10.3390/jcm13010087.
Preston LE, Chevinsky JR, Kompaniyets L, Lavery AM, Kimball A, Boehmer TK, et al. Characteristics and Disease Severity of US Children and Adolescents Diagnosed With COVID-19. JAMA Netw Open. 2021;4:e215298. doi: 10.1001/jamanetworkopen.2021.5298.
Halasa N B, Spieker AJ, Young CC, Olson SM, Newhams MM, et al. Clin Infect Dis. 2023;76:e280-90. doi: 10.1093/cid/ciac477.
Shekerdemian LS, Mahmood NR, Wolfe KK, Riggs BJ, Ross CE, Mckiernan CA, et al. Characteristics and Outcomes of Children with Coronavirus Disease 2019 (COVID-19) Infection Admitted to US and Canadian Pediatric Intensive Care Units. JAMA Pediatr. 2020;174:868-73. doi:10.1001/jamapediatrics.2020.
Cotugno N, Amodio D, Buonsenso D, Palma P. Susceptibility of SARS-CoV2 infection in children. Eur J Pediatr. 2023;182: 4851-7. doi: 10.1007/s00431-023-05184-w.
Gonzalez-Dambrauskas S, Vasquez-Hoyos P, Camporesi A, Cantillano EM, Dallefeld S, Dominguez-Rojas J, et al. Paediatric critical COVID-19 and mortality in a multinational prospective cohort. Lancet Reg Health Am. 2022;12:100272. doi: 10.1016/j.lana.2022.100272.
Khera N, Santesmasses D, Kerepesi C, Gladyshev. COVID-19 mortality rate in children is U-shaped. Aging. 2021;13:19954-62. doi: 10.18632/aging.203442.
Bertran M, Amin-Chowdhury Z, Davies HG, Allen H, Clare T, Davison C, et al. COVID-19 deaths in children and young people in England, March 2020 to December 2021: An active prospective national surveillance study. PLoS Med. 2022;19:e1004118. doi: 10.1371/journal.pmed.1004118.
Centers for Disease Control and Prevention. Underlying Conditions and the Higher Risk for Severe COVID-19. [accessed October 12, 2024] Available at: https://www.cdc.gov/covid/hcp/clinical-care/underlying-conditions.html
Choi JH, Choi SH, Yun KW. Risk Factors for Severe COVID-19 in children: A systematic Review and Meta-Analysis. J Korean Med Sci.2022;37: e35.
Woodruff RC, Campbell AP, Taylor CA, Chai SJ, Kawasaki B, Meek J, et al. Risk Factors for Severe COVID-19 in Children. Pediatrics. 2022;149:e2021053418. doi: 10.1542/peds.2021-053418.
Moeller A, Thanikkel L, Duijts L, Gaillard EA, Garcia-Marcos L, Kantar A, et al. COVID-19 in children with underlying chronic respiratory diseases: survey results from 174 centres. ERJ Open Res. 2020;6:00409-2020. doi: 10.1183/23120541.00409-2020.
Shi T, Pan J, Katikireddi SV, McCowan C, Kerr S, Agrawal U, et al. Risk of COVID-19 hospital admission among children aged 5-17 years with asthma in Scotland: a national incident cohort study. Lancet Respir Med. 2022;10:191-8. doi: 10.1016/S2213-2600(21)00491-4.
Ferraro VA, Zanconato S, Carraro S. Impact of COVID-19 in Children with Chronic Lung Diseases. J Environ Res Public Health. 2022;19:11483. doi:10.3390/ijerph191811483
Gao P, Kang LY, Liu J, Liu M. Immunogenicity, effectiveness, and safety of COVI-19 vaccines among children and adolescents aged 2-18 years: an updated systematic review and meta-analysis. World J Pediatr. 2023;19:1041-54. doi: 10.1007/s12519-022-00680-9.
Hesse EM, Hause A, Myers T, Su JR, Marquez P, Zhang B, et al. COVID-19 Vaccine Safety First Year Findings in Adolescents. Pediatrics. 2023;151:e2022060295. doi: 10.1542/peds.2022-060295.
Voleti N, Reddy SP, Ssentongo P. Myocarditis in SARS-CoV-2 infection vs. COVID-19 vaccination: A systematic review and meta-analysis. Front Cardiovasc Med. 2022;9:951314. doi: 10.3389/fcvm.2022.951314.
Powell AA, Dowell AC, Moss P, Ladhani SN; sKIDs Investigation Team. Current state of COVID-19 in children: 4 years on. J Infect. 2024;88:106134. doi: 10.1016/j.jinf.2024.106134.
Gurdasani D, Bhatt S, Costello A, Denaxas S, Flaxman S, Greenhalgh T, et al. Vaccinating adolescents against SARS-CoV-2 in England: a risk-benefit analysis. J R Soc Med. 2021;114:513-24. doi: 10.1177/01410768211052589.
Price A M, Olson SM, Newhams, MM,Halasa, NB,Boom JA, SAhni LC, et al. BNT162b2 Protection against the omicron variant in children and adolescents Engl J Med. 2022;386:1899-909. doi:10.1056/NEJMoa2202826.
Arrazola P, Fernández Prada M, Gil Á, Gómez Rial J, Hernán C, Menéndez R, et al. New COVID-19 vaccination recommendations in Spain: Optimizing for next seasons. Enferm Infecc Microbiol Clin. 2025;43:36-46. doi: 10.1016/j.eimce.2024.08.006.
14a: COVID-19 - SARS-CoV-2. In; Green Book. [accessed October 12, 2024] Available at: https://assets.publishing.service.gov.uk/media/66e7fbf624c4f1826d81bb32/Greenbook-chapter-14a-20240916.pdf
Panagiotakopoulos L, Moulia DL, Godfrey M, Link-Gelles R, Roper L, Havers FP, et al. Use of Covid-19 Vaccines for Persons Aged =>6 Months: Recommendations of the Advisory Committee on Immunization Practices - United States, 2024-2025. MMWR Morb Mortal Wkly Rep. 2024;73:819-24. doi: 10.15585/mmwr.mm7337e2.
Goldman RD, Bone JN, Gelernter R, Krupik D, Ali S, Mater A, et al. National COVID-19 vaccine program progress and parents' willingness to vaccinate their children. Hum Vaccin Immunother. 2021;17:4889-95. doi: 10.1080/21645515.2021.1999144.
Aldridge SJ, Agrawal U, Murphy S, Millington T, Akbari A, Almaghrabi F, et al. Uptake of COVID-19 vaccinations amongst 3,433,483 children and young people: meta-analysis of UK prospective cohorts. Nat Commun. 2024;15:2363. doi: 10.1038/s41467-024-46451-0.
Miraglia Del Giudice G, Napoli A, Corea F, Folcarelli L, Angelillo IF. Evaluating COVID-19 Vaccine Willingness and Hesitancy among Parents of Children Aged 5-11 Years with Chronic Conditions in Italy. Vaccines. 2022;10:396. doi: 10.3390/vaccines10030396.